Introduction: Computer navigation in neurosurgery has become routine, and rehearsing a procedure is now possible using three-dimensional (3D) simulation modules with haptic feedback. Recent reports demonstrate improved surgical skills after time on a simulator, but even the most robust simulators lack appropriate tactile and spatial feedback. Clipping an intracranial aneurysm requires the assimilation and processing of a variety of datasets. Work hour restrictions limit exposure and interventional treatment has supplanted craniotomy and clipping for many aneurysms, resulting in even less experience for those in training.
Rapid prototyping has been used extensively in industry and construction to create models. The use of stereolithography (3D printing) allows for the manufacture of anatomically accurate lifesize 3D models of the skull and intracranial vasculature.
Methods: Using a technique that involves exporting surface-rendered CT datasets, a 3D printer, and fused deposition methodology (FDM), we printed 8 skulls in patients with unruptured aneurysms scheduled for surgical clipping. Each skull was printed with a window to simulate craniotomy. Work on the model in a simulated OR setting enabled planning the extent of the craniotomy and bone removal, the approach to the aneurysm, the configuration of the aneurysm in the line of approach, and the appropriate clip selection before the procedure.
Results: Residents reported improved understanding of the complex anatomy and approach, and at times accurately predicted the type and angle of clip application. They reported being more easily able to follow the step-wise exposure of the lesion than in cases where they had not rehearsed on a model. The 3D models also enhanced family and patient education.
Conclusions: 3D printing of cerebrovascular anatomy for training allows “surgical rehearsal” on anatomically accurate models with actual aneurysms with short turnaround time. In contrast to cadaveric dissection, models are printed with actual life-size patient-specific vascular pathology.
Patient Care: It will improve patient care by minimizing surgical errors, through rehearsal of the actual procedure on realistic anatomical models of vascular pathology.
Learning Objectives: By the conclusion of this session participants should be able to understand the concept of stereolithography and its use in modeling intracranial pathology, and discuss its use in other areas of neurosurgery.